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Compassion Fatigue Coping Strategies of Filipino Nurses and Physicians ] October 22, 2012

Compassion Fatigue:
Coping Strategies of Filipino Nurses and Physicians
Basmayor, Anthony Wilfred B and Ramiro, Laurie S. University of the Philippines Manila

Abstract
This study sought to identify coping strategies of nurses and resident physicians in relation to Compassion Fatigue - a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress. A total of 70 respondents from Metro Manila composed of 60 nurses and 10 resident physicians were sampled purposively to participate in the study. The study used a mixed design method consisting of a survey and a followup interview on selected participants. Pearson Correlation, and Spearmans rho was used for the quantitative part. On the average, nurses and physicians in Metro Manila appeared to have moderate level of compassion fatigue. Results showed significant correlation between compassion fatigue and age, with younger respondents experiencing higher level of compassion fatigue. Furthermore, compassion fatigue appeared to be significantly correlated with general health condition. Also, working harder and calming ones self was the coping strategy most used by nurses and physicians to cope up with compassion fatigue. Recommendations for policies and programs were made to give nurses and physicians support and assistance in relation to compassion fatigue. Keywords: compassion fatigue; nurses; physicians; coping strategies

Introduction
Not only have those who experienced firsthand traumatic events and devastating illnesses suffer but also those who care for the distressed. Studies on psychosocial stressors exposure, such as critical physical, mental and social needs, as well as traumatic experiences, most often involve

individuals directly in pain and trauma. Few studies have been conducted to ponder on those who give the actual support and care, which includes nurses and physicians. According to Babbel (2012), studies shows that medical personnel, psychologists and other social workers may experience trauma symptoms alike to those of their clients.

Furthermore, researchers speculate that emotional impacts of hearing traumatic stories could be passed on through deep psychological processes contained in empathy a phenomenon called

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Compassion Fatigue, also known as Secondary Traumatic Stress Disorder (Adams, Boscarino, & Figley, 2008). Compassion Fatigue has always been linked with the study of burnout, the former used in relation to rescue-caretaking responses and the latter with assertiveness-goal achievement

patients, which contains the role of the nurse to establish a caring relationship, unconditional acceptance and spend caring moments with the patient (Watson, 2008) which makes them susceptible for compassion fatigue. Figley (1995) said that these helpers may be subsequently traumatized through their efforts to empathize and show compassion as stated in Figleys Compassion Stress and Fatigue Model. This frequently leads to insufficient self-care behaviors and augmented self sacrifice in the helper role (Figley, 1995). In a study conducted by Abendroth and Flannery (2006) on compassion fatigue, 78 percent of hospice nurses in Florida were found to be at a moderate to high risk of CF. On a more recent study, average compassion fatigue score among Oncology nurses in ProQOL R-VI was 15.2 (SD=6.6) (Potter, et al., 2010), Results were higher than the average score of 13 reported by Stamm (2009). Numerous researchers have identified

response (Yoder, 2010). Anewalt (2009) on a study on burnout, defined compassion fatigue as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress. Furthermore, it was also used to mean a unique form of burnout that affects individuals in caregiving roles (Joinson, 1992) and was

characterized by deep physical and emotional exhaustion and a pronounced change in the helpers ability to feel empathy for their patients, their loved ones and their co-workers (Mathieu, 2007). Moreover the term was also equated to secondary victimization (Figley, 1995), vicarious traumatization (Pearlman, 1999), and thought to be a cost of caring (Figley, 1995). Compassion fatigue is an occupational hazard, approximately everyone who cares about their patients/clients, eventually develop a certain amount of it, with just varying degrees of severity (Mathieu, 2007). Watsons Theory of Transpersonal

symptoms of compassion fatigue which consists of different physical, mental, emotional, social and psychological symptoms. Physical manifestations of compassion fatigue includes headaches, digestive problems (e.g. diarrhea, constipation, upset

stomach, muscle tension) sleep disturbances (e.g. inability to sleep, insomnia, too much sleep), fatigue, cardiac symptoms (e.g. chest pain/pressure, palpitations, tachycardia) (Figley, 1995; Gentry, Baggerly, & Baranowsky, 2004), exhaustion,

Caring/Human Caring is grounded on the basis of emphatic relationship between caregivers and

difficulty and breathing (Mullins, 2004). Mental symptoms include impaired ability to make

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decisions and care for clients/patients (Mathieu, 2007) and difficulty concentrating (Mullins, 2004). In terms of emotional symptoms, mood swings, restlessness, irritability, oversensitivity, anxiety, excessive use of substances (e.g. nicotine, alcohol, illicit drugs), depression, anger and resentment, loss of objectivity, memory issues, poor concentration, focus, and judgment (Figley, 1995; Gentry, Baggerly, & Baranowsky, 2004; Lombardo, 2010; Mullins, 2004). Furthermore, symptoms in

traumatized or in great pain, which may lead to the caregivers depression, increased burden, caregiver strain, and decreased relationship quality.

Caregivers of family members with dementia experience events that lead formal caregivers towards compassion fatigue; empathic ability and concern, prolonged exposure to perceived

suffering, no sense of satisfaction, and competing life demands. Gaining a better understanding of the extent to which nurses and physicians are affected by compassion fatigue is critical for a positive and nurturing practice environment. Although

occupational/social aspect includes the feeling of isolation from family, aggressiveness, sarcasm, uncooperativeness (Mullins, 2004), avoidance or dread of working with certain patients, reduced ability to feel empathy towards patients or families, frequent use of sick days and lack of joyfulness (Lombardo, 2010). Day & Anderson (2011) conclude that

researches has been done to dealt on the phenomenon of compassion fatigue, there are no studies on its prevalence in the country, its manifestations on Filipino caregivers and the strategies being practiced to address the problem which the present research aims to study.

compassion fatigue is a process and a result of a caregivers empathy and sympathy to a person

____________________________________________________________________________________

Research Problem:
What are the different coping strategies of Filipino nurses and physicians in relation to compassion fatigue?

Specific Objectives
1. To determine the prevalence of Compassion Fatigue physicians Hospital among at Filipino the nurses and

Philippine

General

General Objective:
To identify coping strategies to compassion fatigue of Filipino Nurses and Physicians in the Philippine General Hospital, Metro Manila.
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2. To identify demographic and occupational factors that leads to the development of Compassion Fatigue among Filipino nurses

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and physicians at the Philippine General Hospital 3. To identify physical, social and emotional manifestations of compassion fatigue

fatigue is critical for a positive and nurturing environment required by their profession.

Although, researches has been done to address the problem, results are Western-based, thus, the need for a local study. Furthermore, its perceived usefulness and relevance to the medical field, personal needs and occupational needs of nurses and physicians in the country is highly significant. Moreover, the study is also made to be

among Filipino nurses and physicians at PGH.

4. To determine coping strategies practiced by


Filipino nurses and physicians at PGH to Compassion Fatigue

Significance of the Study


With todays growing population of medical professionals, knowledge of behavioral problems and issues that may be affecting them in their personal and professional lives is of great importance. In accordance with the study, an understanding of psychological and environmental stressors related to the development of compassion

springboard for recommendations on policies and strategies on the welfare of medical professionals. Lastly, this study can be useful in the area of social psychology, particularly in the field of attitudes and social cognition. It could also contribute to knowing predispositions of attitudes and in predicting behavior.

Methodology
Research Design
The study is a mixed design research in nature. A descriptive cross-sectional design was chosen for the quantitative part of the study utilizing a self-administered survey-type responses on the survey which will serve as the qualitative part of the study.

Study Population and Sampling Scheme


The target population for the present inquiry included nurses and resident physicians in the Philippine General Hospital (PGH) who meets the following inclusion criteria: (1) 20 years old and older (2) are currently employed in the Philippine General Hospital (3) interacting directly and

questionnaire to be filled out by nurses and physicians currently working in PGH. After which, a one-to-one interview with selected respondents will be made to have an in-depth data regarding

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regularly with patients and their families and (4) are working in the following Departments: a. Pediatrics b. Oncology c. Rehabilitation Medicine d.

providers, specifically nurses and physicians. It intends to determine, its prevalence in the country; its manifestations in the forms of physical, emotional and social, and mental stresses and problems; the factors that may be causing it and; the coping strategies practiced by nurses and physicians in response to comapssion fatigue.

Emergency Medicine Services e. Psychiatry. The study population consisted of physicians, 73 nurses and

with a non-participation rate of 10

percent factored in. Overall, it will include at least 81 respondents (alpha=0.05, e=.05, p=0.06, q=0.95).

n = (Z1-/2) pq e n = (1.96) (0.05)(0.95) 0,05 n = 72.96 Scope and Limitation


The study focuses on the phenomenon of compassion fatigue manifesting on health care

The results of this research limits itself to nurses and physicians from the Philippine General Hospital. In turn, the results may not applicable to other nurses and physicians in other

hospitals/institutions or to all nurses and physicians in general.

_________________________________________________________________________________Conceptual Framework

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Definition of Variables

Compassion Fatigue The total score on the compassion fatigue scale, consisting of scores from the physical stress, emotional stress and social stress scales. With total scores of 84-120 a high level of compassion fatigue, 55-83 as moderate degree of compassion fatigue and 40-54 as low level of compassion fatigue. Empathy The score in the empathy scale, consisting of items 1 5 of the second part of the questionnaire, with scores ranging from 20-16, 15-11 and 10-4 as high, moderate and low level of empathy, respectively. Physical Stress defined as the score in the physical stress scale, consisting of items 7, 9, 10, 18, 24, 28 and 32 of the second part of the questionnaire, which includes items about physical manifestations of compassion fatigue such as sleep disturbances, headaches, eating disturbances, etc. Emotional Stress defined as the score in the emotional stress scale, consisting of items 1, 2, 3, 4, 5, 6, 8, 11, 16, 17, 19, 20, 22, 25, 26, 27, 30, 31, 33 and 35 of the second part of the questionnaire. The scale included items regarding emotional stress such as difficulty making decisions, aggresiveness, anxiety, depression, etc. Social Stress - defined as the score in the social stress scale, consisting of items 12, 13, 14, 15, 21, 23, 29 and 34 of the second part of the questionnaire, with items included in the social stress scale are estrangement, feeling of isolation, decreased empathy etc. Coping Strategies defined as score in a likert-scale provided in the third part of the questionnaire which includes common coping strategies practiced by nurses and physicians as reflected in the literature, such as getting professional help, increased alcohol intake, acceptance that their feelings are natural, talking about the problem with someone, etc.

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Theoretical Framework

Basically, between the caregiver and the patient, in the process of treatment, relationship-based

relationship, unconditional acceptance and caring moments with the patient. Watson also viewed the nurse-patient relationship as enmeshed with each others feelings, where there is reciprocal sharing between those involved. This theory advocates relationship-based nursing (RBN). And in the core of RBN is empathy and the actual communication of this empathy to the patient and the family (Figley, 1995).

nursing applies, which is contained in the process of empathy and communication. Furthermore, in the process of empathy happening between the caregiver and the patient, some personal and occupational factors makes them susceptible to compassion fatigue (Figley, 1995). This model is reflected in the following theories:

Watsons Theory of Transpersonal Caring is grounded on the basis of emphatic relationship between caregivers and patients, which contains the role of the nurse to establish a caring
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Figleys Compassion Stress and Fatigue Model developed by Charles Figley (1995) is based on the assumption that empathy and emotional energies are the leading forces in
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working well with suffering, establishing and maintaining therapeutic relationships and delivering successful treatments (Figley, 2002).

Agree to Strongly Disagree in four domains Empathy, Physical Stress, Emotional Stress, Social Stress - with an overall score 84-120 as high compassion fatigue level, scores in the range of 5583 as average and low total scores of 40-54 as low

However, these traits of caregivers also make them susceptible to succumbing to the costs of caring. In viewing the world through the eyes of their patients, the caregivers not only bear with the suffering but suffer as well (Figley, 1995).

level or at-risk.

A validated Empathy Scale with Cronbachs Alpha = 0.812 was used to measure empathy, scores ranging from 20-16, 15-11 and 10-5 as high, moderate and low level of empathy, respectively. Also, validated Physical Stress Scale with Cronbachs

Instrumentation
The quantitative phase of the study focused on the level of compassion fatigue of nurses and physicians as exhibited in physical, emotional and social stresses. The pre-tested questionnaire is generally a combination of descriptive and scale measurements and was designed in three parts.

Alpha = 0.624, Emotional Stress Scale with Cronbachs Alpha = 0.866 and Social Stress Scale with Cronbachs Alpha = 0.711 was used to

measure the three domains under compassion fatigue.

Lastly, the third section of the questionnaire included a 3-point Likert-scale meauring how often

The first section of the questionnaire consisted of sociodemographic profile of the respondent such as age, sex, marital status, number of years in medical practice, his general health condition and other occupational information such as number of hours per day duty/exposed to traumatized and seriuoslyill patients.

the respondent use a certain coping strategy in relation to compassion fatigue. Based from the results of pilot testing and expert validation, items were revised as needed.

Data-Collection Procedure
A questionnaire is formulated to determine adverse events encountered by health care

The second section is a 4-point likert-type Compassion Fatigue Scale with Cronbachs Alpha = 0.906 developed to measure the severity and prevalence of compassion fatigue from Strongly
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providers and to identify factors that may lead to compassion fatigue among nurses and resident physicians as well as its manifesttions and how these are dealt on.
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lowest score of 1 to those who strongly disagree. Then, after coming up with an approved proposal, the researcher will coordinate and submit a letter to the director of the Philippine General Hospital for the conduct of the study. With the directors approval and endorsement, the For negatively stated items, the scoring is reversed. Total scores of 106-150 would mean high compassion fatigue level, scores in the range of 68105 would mean average and low total scores 30-67 would imply low.

researcher will be distributing questionnaires to departments/units, nurses stations around the hospital. Ethical principles of research will be adhered to at all times. Anonymity and Data gathered through the questionnaire administered among nurses and physicians will be encoded in Microsoft Excel and will be analyzed using SPSS. These softwares will also be used fo r statistical treatment of the data.

confidentiality will be ensured and the results will only be used in the purpose of the study. Participation will be voluntary and respondents can withdraw themselves from the research at any time.

To know which items the respondents reacted most positively and to which most negatively, the mean per response per item will be

After the survey, interviews on key respondents will be requested and scheduled.

computed.

Then significant

the

researcher among

will

determine and

differences

nurses

Data Management Plans


Data will be encoded and tallied using Microsoft Excel program and will be analyzed using the Statistical Package for the Social Sciences (SPSS).

physicians prevalence and intensity of compassion fatigue according to their sex, age and number of years in practice. After which, a one sample T-test will be performed and will be making use of the pvalue to interpret scores and examining significance among variables.

Data Analysis Plans


As to being Likert Scales, scoring will be made for the 3rd and 4th part of the questionnaire. For positively stated questions, the highest score of 4 will be given to those who strongly agree, 3 for those who agree, 2 for those who disagree and the
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Data source triangulation will be employed by the researcher for comparig the information gained from quantitative analysis of the responses of the respondents and the interviews.

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Ethical Considerations
On the questuonnaires distributed, before the main questionnaire, there is a portion that informs the respondents regarding important points about the study, including the nature of the study and its objectives. The respondents are to sign below if they agree to participate in the study. The researcher assured the respondednts utmost confidentiality regarding the experiences they shared and promised to keep their identity anonymous. For the qualitative interview, the reseacher will ask the respondents permission to use a tape recorder. Finally, for information disseminaation, the researcher will give the written report regarding the results of the study to the respondents.

Results

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